Provider Demographics
NPI:1629587100
Name:GRACIA, BERNADETTE ROSARIO (PT)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:ROSARIO
Last Name:GRACIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9006 CRESTING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-1509
Mailing Address - Country:US
Mailing Address - Phone:979-282-1434
Mailing Address - Fax:
Practice Address - Street 1:9006 CRESTING RIDGE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406
Practice Address - Country:US
Practice Address - Phone:979-282-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1227445225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist